An integrated framework for clinical surveillance in multiple sclerosis: An evidence-informed narrative review

An Integrated Framework for Clinical Surveillance in Multiple Sclerosis: an evidenceinformed narrative review Background: Multiple sclerosis (MS) requires structured lifelong surveillance across clinical, imaging, safety and patient-centred domains. We aimed to integrate relevant recommendations and evidence into a practical framework for longitudinal care.

We conducted an evidence-informed narrative review of PubMed/MEDLINE, Embase and the Cochrane Library from inception to December 2025, supplemented by society and institutional guidance and reference-list searching. Evidence was synthesised across clinical and cognitive assessment, neuroimaging, laboratory safety monitoring, emerging biomarkers, treatment escalation and de-escalation, vaccination, reproductive health, and a tiered minimal core monitoring set. No formal risk-of-bias assessment or evidence grading was performed.

The proposed framework integrates clinical and cognitive measures, conventional MRI and drug-specific safety monitoring. NEDA-3 is adopted as the operational treat-to-target framework; NEDA-4 and biomarker-enhanced composites are discussed as emerging extensions. Serum neurofilament light chain and glial fibrillary acidic protein provide complementary prognostic information but do not independently identify progression independent of relapse activity or mandate treatment escalation. Confirmed inflammatory activity is distinguished from disability accumulation and adjunctive biomarker or quantitative imaging signals. Vaccination, reproductive health and symptomatic management are incorporated alongside authorproposed essential, recommended and advanced monitoring tiers.

This framework is intended to support coordinated, risk-adapted MS surveillance. Its operational recommendations and monitoring tiers require prospective validation, and implementation should reflect patient characteristics, treatment-specific requirements and local resources.